Responses to liner for small KD

Responses to liner for small KD

Below is my original post followed by the responses. Thank you for all the
great suggestions. There seems to be a lot of good choices for this
situation. This Listserv is awesome.
 
 
Original post: We are looking for suggestions on the best liner (TEC, Alps,
Alpha, Ossur, etc) for a very small, young, knee disarticulation amputee.
His limb is 22 cm in length, 33 cm in circumference proximally and 17
distally. He has good/great distal end bearing capability and we are considering
fabricating a 3/4 length socket with suction or expulsion valve and sleeve
suspension. At present we are leaning toward Custom TEC or Alpha. Any feedback
or suggestions will be appreciated.

 
Responses:
 
One option to consider is the Evolution SP Liner. Invented by Stan
Patterson, CP, of Orlando, Florida, the Evolution SP Liner is durable,
comfortable and is fit as a custom cushion or pin liner. Stan, with more
than 14 years of patient care experience, noticed a void in the liner
market, and wanted a custom liner with the flow characteristics of
urethane and the durability of silicone to provide the optimal interface
for his patients. Made of a platinum-cured silicone, the Evolution SP
Liner is custom made from a mold of each patient's residual limb. This
custom liner assures that the patient is receiving a socket interface
that is anatomically shaped to fit each patient's limb and provides
uniformly distributed forces to the tissues. The liner can also be
created with an external shape that is customized as well, such as
needed for stove pipe designed symes or KD sockets. Additionally, the
clinician will feel confident that he/she has provided the patient with
a skin interface that is biocompatible, durable and will remain
virtually odor free.
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You can use the heat moldable alps liner as well, you can bill it as custom.
 I used this on a congenital PFFD patient. He has a fused knee and a symes
amputation. Like a Knee disart. We used the moldable liner and an expandable
wall flexible inner socket to allow for his bulbous distal end and
suspension. Has worked fairly well for a couple weeks now.
*************
Tec and alpha are good choices. No cream with alpha though and sometimes
problems with tec longevity... How diligent do you expect this child to be
about sock regulation? If you are already using a lot of tec and are
comfortable with the liners, then you know how well it can fit if done
properly. If not, the learning curve istreacherous.

Alpha has good distal cushion for end bearing.
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You might want to look at the ALPS sticky thermo liner
Model STFR-size- 3mm. It is sticky like Alpha's gel
but can be heat molded so you can now bill the custom
liner code, as well it is much less expensive than TEC
or other custom liners. You can then use the VIVA
sleeve by ALPS for suction suspension. You may call
ALPS and ask for the valve in the VIVA to be placed
more proximal for this situation. This has worked well
for me in the past. Just a thought!
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We have a few of these at the shrine but for bigger kids. Use the
Coyote side mount lanyards on Alpha cushion liners. Instead of the stock
straps and locks, use smaller Velcro backed Dacron straps as lanyards with
Velcro on the socket. For the smaller kids, we usually start them with a
silesian belt or variant. As their anatomy becomes more defined, supra
condylar suspension with socks is our preference (be it bocklite liner or
window). We mold to the gluteal fold not quite ischial weight bearing but
more aggressive than the 3/4 socket. Be careful to give the socket a
modified quad shape I know I know no one does the quad socket anymore) to
help control rotation. This socket will become a 3/4 socket over time.
Checkout the Seattle Childsplay feet and shin faring for the discontinuous
cover.
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For durability, I would use an Alps clear silicone nonlocking liner. 1.5mm.
thickness is easier to don/doff, but I would try a 3mm. thickness (if they
have it) for the best durability.
***********
ive been using the otto bock custon pure silicone liners and had great
results you should give your sales rep a call. let me know how it goes
**************
I just fit a 2 and 1/2 year old KD with a OWW peapod
cushion liner. I windowed medial and added a velcro
strap (feeding it through slots for increased pull).
My patient has good end bearing, but I went with high
trimlines for greater control because I put an
articulated knee on. So far, so good. Sounds like
your patient has a more conically shaped limb than
mine, so I'm not sure if the Alpha liner would stretch
that much.
***************
Although I have not worked with a small patient such as yours, I have done
more than a few adult KD's. I have had great success using what TEC (now
Otto Bock) called the Belgian Style KD socket which is very short and is
windowed. An OB AKquire liner is sized up and a sealing sleeve goes over the
frame providing suction with a valve as you mentioned. Works great!! Speak to
Scott Tjaden or Paul Singh @ Bock: They will guide you all the way through.
Please feel free to contact me if you need further info on the casting
method they suggest. Regards,
**************
If you could go silicone ,the distal would pack out the gel as bad as in
Alphas. I might even look into ALPs. The Viva sleeve could be your purge valve
and suspension. Hows the condyle shape(bulbous or shaved)? I used to use the
Iceross clears and donn with a wet fit for KDs to save room on the distal gel
thickness. They were always a little tough at first but eventually settled
into place. Stay away from the Silipos,they shred in this application. The TEC
would good for pad placement. I would most likely settle for an Alpha and be
prepared for long term replacements. Good luck.
*************
In regards to your question as to the best liner for your patient, I feel I
have a couple of suggestions that might be of help. First, due to the
measurements of the patient’s limb, they would fit in an Alpha BK liner. I would
recommend a small, 9mm tapered, that would give you 12mm of gel across the
medial and lateral femoral conidials. But proximally you might have to heat
stretch the liner for the best comfort. The distal end should need no modification
to the liner. A second thought would be a medium, 9mm tapered Alpha liner. It
would fit better proximally, but may be loose at the distal end.
If possible, you may want to consider creating a DESIGN liner for this
patient. With this liner, you have the ability to add or take away gel as needed
over any area of the residual limb. You can taper the proximal end of the
liner to 3mm from a starting point that you select. This will create a very
comfortable liner for your patient. The DESIGN liner is still in beta stage, but I
have had great success over the past 6 months using them. I also think with
the ability to add gel as needed, you would be able to create a liner that
may give your patient better suspension as well.
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Heads-up...TEC is having big problems with custom fabrication jobs since
moving to Utah. I have had luck with the Evolution custom liner by
Freedom Innovations. It does not sound like you will be able to find a
pre-made size to fit this kid.
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I've had good success with an Ossur cushion liner in a full length, flexible
inner socket in a rigid frame (to allow the bulbous distal end to pass
through) and a coyote lock to firm up the suspension/rotation control. I
guess it would work OK with a 3/4 length socket, but our guy had some
serious skin grafting and couldnt take all the weight distally. Good luck, I
look forward to the responses!
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Have you looked at the Contex liner from Euro International is a hybrid
polymer gel and has a similar suspension sleeve. If you are making a
3/4 length socket this is a truly dynamic combination in cushion seal
and overall durability. Please call if you have any questions.
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Ossur makes excellent liners that hold up well which is a major plus with
the kids. The sport liner comes as small as 17cm, so you might be in luck.
The dermo liner is good also and more cost effective. Some of the older kids
we work with state that they prefer the dermo over the sport liner.

Ossur also has a peds liner which works but hasn't grabbed me yet.
Although my colleagues seem to like it and these liners are holding up to the abuse
that the kids subject them to.
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Thanks again to all who responded.
Eddie White, CP
Beacon Prosthetics and Orthotics
3911 New Bern Ave.
Raleigh NC 27610